Gun-Control Laws Could Have Chilling Effect on Psychiatric Treatment

My psychiatrist once told me that his own analyst had remarked that if we were held responsible for our thoughts, we would all be put in jail. Bob Dylan made a similar point years ago when he sang, "If my thought-dreams could be seen, they'd probably put my head in a guillotine."

Thankfully, no one has guillotined Bob Dylan, and thankfully we are not held responsible for our thoughts. Nor should we be legally liable for the outlandish statements that we make to our psychiatrists, our closest confidants.

And yet the newly passed New York State law, the NY SAFE Act, as well as the president's new executive order on mental illness reporting, might put that confidentiality into jeopardy.

I am a strong advocate for gun control and believe that no civilian should own an assault weapon or high-capacity magazine. I also believe that those with a mental disorder, like me, should not own firearms of any kind. As readers of this column know, I was once diagnosed with schizophrenia and I take anti-psychotic as well as anti-depressant medication to this day. I do not own a gun, and I do not want one.

I have never forgotten a story my father told me when I was young. It was about a boy in his neighborhood, who was horsing around with an old rifle; it inadvertently went off. Except it fired backward and killed the boy. That story has stayed with me over the years because it speaks to the inherent danger of guns. Even beyond acts of homicide and suicide, accidents can happen when guns are not properly cleaned and safely secured.

As dangerous as guns are, it is equally dangerous to our civil liberties if reporting provisions in laws, like the NY SAFE Act, are written broadly.

It strikes me, as it struck the New York Times editorial board, that the provision in the New York law, in which mental-health workers must report to authorities "when they have reason to believe that patients could harm themselves or others," represents a dangerous intrusion into the confidentiality agreements between psychiatrists and consumers.

I can't tell you how many times I have made absurd statements to my psychiatrist, statements I would probably never make to anyone else. I can't recall making a threatening statement, but if I am honest, I probably have on occasion stated, "I could kill that person."

Who hasn't made a similar statement over the years? In fact, people make statements like that every day outside of a psychiatrist's office, and we don't police them.

If we are now going to police such statements, not only in New York but also nationwide, since the president's new set of executive orders on gun control includes one on reporting threats made by patients, then we are going to trample on and censor the 1st Amendment rights of citizens who in all likelihood are simply airing out grievances in a therapeutic setting.

I can't speak for all of those in therapy, but I can guarantee you that if I made a threatening statement, it would be in an over-the-top fashion, layered with more than a degree of irony, even ridiculousness. Never in a million years would I act on it. Never in a million years would I behave violently.

It is one thing to think violent thoughts or even make a threat in a private forum. It is another thing altogether to commit a violent act.

It is worth pointing out, as Dr. Michael Stone, a forensic psychiatrist, did in a recent front-page story in the New York Times, that "most mass murders are done by working-class men who've been jilted, fired, or otherwise humiliated."

As Benedict Carey and Anemona Hartocollis reported in that Times article, "The sort of young, troubled males who seem to psychiatrists most likely to commit school shootings -- identified because they have made credible threats -- often do not qualify for any diagnosis."

They noted in their piece, "People with serious mental disorders ... account for only about 4 percent of violent crimes overall."

That corresponds with studies I have seen over the years, indicating that those with severe mental illness but no substance abuse problems commit roughly 3 percent to 4 percent of violent crime.

Even if we accept, as Dr. Stone suggested, that those with severe mental disorders commit 20 percent of mass and serial murders, that is still only 20 percent. The rest, the lion's share, are committed by those angry, frustrated, young men I have written about before, like the white supremacist who shot up the Sikh temple last year, or Nidal Malik Hasan, the Fort Hood killer, or Timothy McVeigh, the Oklahoma City bomber.

Not one of those men was or is known to be mentally ill.

And yet we still have TV talking heads insisting that psychiatrists have to inform on their patients, the vast majority of whom are harmless. What if a patient does not own a gun, but makes an overblown threat for shock value? What if a patient has never been violent in his life, but likes to air out his issues in the privacy of his psychiatrist's office?

I am all for gun control and believe that in very specific situations it may be that a wise psychiatrist could determine that a specific threat to a specific person warrants a report to law-enforcement. But that is not how the NY SAFE Act and the president's executive order were written.

I agree with most of the other executive orders on gun control just issued by President Obama. And I have argued in this space that the president should use his executive authority to ban semiautomatic guns, assault weapons and high-capacity magazines, if the Congress won't pass commensurate legislation. But I am opposed to a broad reporting provision in any law, whether state or federal, that might cast a pall over and have a chilling effect on the relationship between clinicians and patients.

We have to be able to speak freely in our psychiatrist's office. That is as inalienable a right as anything our founders intended.